AORTA

The Dutch AORTA programme (the website can be switched to English) is in the process of creating a nationwide infrastructure for the exchange of data between healthcare providers. AORTA uses HL7 version 3 messages as its core mechanism for information exchange. The initial specifications have been created in 2003.

The Dutch Ministry of Health, Welfare and Sport is currently working on a national system which will enable caregivers to electronically share patient data, the Electronic Health Record. This development takes place in close collaboration with the National IT institute for Healthcare (NICTIZ) and the CIBG agency.

The first two chapters of this Electronic Health Record are an electronic medication record (EMD) and en electronic general practitioner’s summary file to be used by locum GP’s (WDH). Right now, these two chapters are being brought into operation in 12 regions, 6 for each chapter. These regions are called ‘front runners’. The aim is to start national implementation of these two electronic applications by 1 January 2007.

In order to provide safe and reliable electronic communications, it is necessary for patients and caregivers to be able to electronically identify themselves. For patient identification, everyone in the Netherlands will be issued a Citizen Service Number (BSN). This number is being developed by the Ministry of the Interior and Kingdom Relations and will replace the current social-fiscal number.

Care providers will be given an identity pass known as the ‘UZI’pass (Unique Healthcare provider Identification, see UZI Website (switch to English). Both BSN and UZI will be mandatory when electronically exchanging patient data.

For a 10 minute high-level overview of the architecture, see the Windows Media video or the Apple Quicktime video. These are aimed at healthcare providers and as such don't mention HL7.

Use of HL7 v3

All exchanges of data between components of the architecture are based on HL7 version 3. The specifications (both for the architecture as well as the HL7 v3 messages) have been mostly published in a bi-annual cycle. The HL7 messages are mostly based on the March 2004 Development Edition (a.k.a. Ballot 7); parts of later specifications have been pre-adopted and included in the AORTA specifications. In 2008/2009 a major new version of the HL7 v3 specifications will be published based upon the then-latest Normative Edition.

HL7 Domains that are used heavily in the implementation include:

• Person Registry (BSN)
• Provider Registry (Persons and Organizations)
• Shared Messages "Act Reference" Topic
• Pharmacy/Medication (EMD)
• Patient Care (WDH, perinatology, dialysis)

..as well as infrastuctural domains such as Data Types, Transmission and Trigger Event Control Act wrappers.

In principle all interactions (and other artefacts) that are used in the implementation are based on the universal HL7 v3 standard. On occasion models have been pre-adopted (i.e. extensions have been included in interactions prior to those extensions bing approved by a committee). All extensions will be turned into proposals and (ultimately) into extensions of the universal standard. This has lead to quite a number of proposals for the domains listed above.

References

• See Ringholm Whitepaper for additional information on the use of HL7 v3 Act Reference Registries.

HL7 v3 Notes

• If an interaction has not been extended from the universal interaction AORTA uses the universal interaction identifier. Dutch specific constraints have to be conveyed as realmCode and profileId. Interactions which have been extended in a non backwards compatible fashion have been assigned interactions with a “NL” realm identifier.
• The realmCode will be “NL” to identify that realm specific constraints as defined by HL7 Netherlands apply, this is especially needed to extend or otherwise change value sets for HL7 vocabulary domains.
• The versionCode indicates "all infrastructure stuff (CMETs, datatypes, vocabulary, transports) as of the point and time the release was published". AORTA is based on the "Ballot 7" Release, even though some parts of the models as well as parts of the schema are based on ITS versions later than ballot 7. It currently contains "NICTIZEd2005-Okt" to indicate this unique mixture of models/ITSs as used in the current project.